Provider Demographics
NPI:1336107846
Name:CHANG CRUZ, FELIX B (MD)
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:B
Last Name:CHANG CRUZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 415348
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-5348
Mailing Address - Country:US
Mailing Address - Phone:800-225-8885
Mailing Address - Fax:508-334-1977
Practice Address - Street 1:60 HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-2205
Practice Address - Country:US
Practice Address - Phone:978-466-4169
Practice Address - Fax:978-466-4164
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA227308207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1319833Medicaid
MA221845OtherUGS
MAJ41626OtherBLUE SHIELD OF MA
MAJ41626OtherBLUE SHIELD OF MA
MAI68009Medicare UPIN
MA221845OtherUGS